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Information about all aspects of finances affected by a serious health condition. Includes income sources such as work, investments, and private and government disability programs, and expenses such as medical bills, and how to deal with financial problems.
Information about all aspects of health care from choosing a doctor and treatment, staying safe in a hospital, to end of life care. Includes how to obtain, choose and maximize health insurance policies.
Answers to your practical questions such as how to travel safely despite your health condition, how to avoid getting infected by a pet, and what to say or not say to an insurance company.

My Survivorship A to Z Guide

Insurance Essential

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Note: This is a sample Survivorship A to Z Guide for a fictitious person we call John. John is just diagnosed with HIV. To view a summary of his answers which led to this Guide, click here.

To get your own free, computer-generated A to Z Guide, click here.

Do everything you can to keep health insurance in force. It pays the bulk of the medical costs of your battle.

You indicated that you have access to the health care system through:

  • A Point of Service (POS) type of health insurance policy
  • An employer

Health insurance may be the most important asset to have for a person living after a diagnosis of HIV. Do whatever is necessary to keep it.

  • Make arrangements with your employer if they are not already in place, for your share of the premium to be paid by payroll deduction. If payment is automatic, your insurance will not be canned due to a missed payment.
  • If your employment ends, exercise your rights to continue your coverage under the law known as COBRA until you replace it on your own or through a new employer. To learn more, see COBRA.  (If you have life insurance through work, consider taking it with you. You may be able to use it as a source of money while still alive. To learn more, see: How To Obtain Money From A Life Insurance Policy.)

If you understand the concept behind your POS type of Health Insurance coverage, rather than just try to remember the details, maximizing use of your insurance will be much easier. [Tell me more]

If you understand the concept behind your coverage, rather than just try to remember the details, living with your insurance will be much easier.

"POS" stands for "point of service."

The model for a POS policy is a combination of two insurance models. One is the old indemnity model - where you have total choice about what doctors to see, what treatments to undergo and when. The other model is the newer managed care model - where the insurance company manages your care. You choose each time you go for care whether to follow the free choice indemnity model or to go into managed care. This moment of choice is known as the "point of service."

With a POS:

  • The insurance company contracts with a network of doctors, and sometimes hospitals, to provide care for a set, pre-determined fee.
  • Each time you need care, you have a choice:
    • You can see a provider in the company's network and get approval for each use of the system -- such as seeing a doctor or getting a treatment. Or
    • You can go outside the network and get a treatment on your own.
  • There are financial incentives to use the doctors the insurance provider contracts with ("network doctors"). Care inside the insurance provider's network may only be subject to a co-pay - a payment you make each time you see a doctor. The amount of co-pay varies with each insurer and plan. Outside the network, you may be subject to a deductible -- a pre-determined amount of money you pay each year before insurance starts at all. After you pay the deductible, you are also likely to be required to pay co-insurance -- a percentage of the bill. For example, if you have a $1,000 deductible and 20% co-insurance, if the bill is $5,000, you pay the first $1,000 plus 20% of the remaining $4,000 which equals another $800.
  • POS policies may also add features from the managed care model in which your freedom of choice is actually limited by the insurance company. For example, there may be a gatekeeper who will determine when and whether you can access care in the network. The choice of what doctor to see and what treatment to take, if any, is should still be yours.

Learn how to maximize use of your POS. For instance,

  • Read your policy to find out what you can and cannot do. Pay special attention to what needs approval before you do it. If you have difficulty reading the policy, ask a friend to do it for you.
  • Pay attention to the amount you have to pay, and for what. More and more costs are being imposed on insureds. With HIV, the amounts you may have to pay can add up quickly. They can add up so much that it's not unusual for people with health insurance to still end up filing for bankruptcy.
  • If your policy requires you to ask permission from a primary care doctor (PCP) to see your HIV specialist, ask for unrestricted access. If you can't get that, ask for a multiple visit pass, such as one that allows you to go to the HIV specialist 5 times before you have to get another pass. Or, while it's not ideal, consider making your HIV specialist your PCP.
  • When there is a question of which treatment to use, learn about all the alternatives so you're not steered to the one that is least expensive for the POS.
  • If you wish to go outside the network, coordinate that doctor with one inside the network in a manner that saves you the most money. For example, you could meet with an out-of-network doctor and decide you wish to have a particular treatment. Ask an in-network doctor to order the tests and provide the treatment in an in-network hospital.
  • Insurance companies do not generally pay for experimental treatments. If a treatment you want could be considered "experimental," work with your doctor to create the strongest argument as to why it's in the insurance provider's interest to pay for it. Get agreement before you take the treatment, or be prepared to pay the entire bill yourself. Perhaps you can find a treatment for free through a clinical trial or from a pharmaceutical company.
  • Don't accept a "no" from the insurance company. Fight for a "yes." Follow the insurance company's appeal process. (Pay close attention to the dates set by the insurance company by which various actions must be taken). Ultimately you can complain to the state insurance department. It supervises all insurance companies which sell insurance in your state.
  • Get help for the fight if you need to.

You indicated that you have your POS health insurance through work. One way to get the insurance company to say "yes" to an in-network request is to ask your employer for help. Since your employer has the strongest relationship with the insurance company, it may have the clout to get what you need.

  • If your insurance is bundled through a tax favored plan, such as a Medical Savings Account, learn about the particular plan and how to maximize its use for your benefit.

If your insurer won't approve the health care you want, follow the insurer's appeal requirements. Be persistent. [Tell me more]

To convince your insurer to approve the health care you want:

  • Enlist your doctor's help.
  • Cite the part of your insurance which shows you are entitled to the care.
  • Follow the company's rules. If the the rules say you have 15 days to appeal, then appeal within the 15 days. Don't expect that you can appeal on day 16 and argue that the one day shouldn't make a difference.
  • When you speak with the insurance company:
    • Keep your emotions under control. It may be personal to you, but it's business to them.
    • Make notes of every conversation. Store your notes with your copy of your insurance.
  • Be persistent. Experience shows it pays off.